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Pharyngoplasty represents one of the most widely performed surgical procedures for the treatment of obstructive sleep apnea (OSA) in the presence of palate-oropharyngeal collapse. The learning curve for pharyngoplasties is steep and success is conditional on the correct use of the sutures and the careful application of the surgical steps in a narrow surgical field. The use of synthetic models may be conveniently and safely employed for hands-on surgical practice in pharyngoplasties, especially when fresh frozen cadaveric specimens are not available. We present the "Pharyngolab", a new simulator for pharyngoplasties.

Oropharyngeal surgery for Obstructive Sleep Apnea (OSA) has evolved from a radical excision of "redundant" soft tissue for the enlargment of the airway to a minimally invasive reconstruction to fulfill both preservation of pharyngeal function and improvement of sleep apnea. Recently, Alianza surgical technique has been successfully introduced as a new, non-resective procedure aimed to treat concentric pharyngeal collapse at the velum using Barbed Sutures. The aim of this study was to show the effectiveness and safety of Alianza technique as standalone surgical treatment in selected patients with moderate-severe OSA and concentric pharyngeal collapse that refused or did not tolerate Continuous Positive Airway Pressure therapy.Effectiveness of the surgical procedure was assessed by means of the Epworth Sleepiness Scale (ESS), Home Sleep Test, and a 0-10 snoring VAS.At the end of our selection process, 26 patients were enrolled, with a mean age of 52.7 ± 9.2 years, that undergone Alianza tecnique. There was a statistically significant reduction in mean post-operative apnea-hypopnea indexes (34.1 ± 11.5-16.3 ± 10.3; p 0.01), mean oxygen desaturation index (29.0 ± 14.5-13.1 ± 9.2; p 0.01), and mean ESS scores (12.1 ± 5.8 and 5.8 ± 4.4; p 0.01).There was also a significant decrease in mean post-operative snoring VAS scores (7.85 ± 1.23 vs 3.2 ± 1.7, p 0.01). There were no major complications.Our preliminary results suggest that Alianza technique is a safe and repeatable surgery. Further studies on a larger scale are needed to confirm these encouraging data supporting the role of Alianza alone or in OSA multilevel surgery in selected OSA patients.

The “Barbed Snore Surgery” is one of the last technical innovations in palatal surgery for Obstructive Sleep Apnea. The availability of a low-cost surgical model able to replicate tissue consistency and main anatomical structures could be fundamental for the spreading of this surgery. The aim of this study was to assess the feasibility of an ex-vivo ovine model in the surgical training of BSS. After adequate preparation of adult lamb heads, a post-graduate student with no surgical expertise was guided by a skilled surgeon in the execution of two BSS procedures: “Barbed Roman Blinds Technique” and “Barbed Anterior Pharyngoplasty”. Anatomical limitations and similarity with the human tissue were assessed and recorded during the simulation. All the procedures were successfully completed. Despite proportional differences, the palatal tissue was assessed as similar in consistency and thickness to the human tissue. The simulation was considered satisfactory and suitable for surgical training. This ex-vivo ovine surgical model could represent the right tool for BSS training thanks to readily available and inexpensive specimens. Moreover, it appears to present the realistic anatomy and tissue consistence essential for an adequate surgical simulation.

Hyaluronic acid (HA) is involved in modulating inflammatory airway processes and mucociliary clearance. Some studies have tested the effectiveness of the topical administration of HA in patients with upper airway diseases with positive preliminary results. A prospective, single-blind, 1:1 randomised controlled study was performed to assess the efficacy and safety of the daily topical administration of 9 mg of sodium hyaluronate in 3 mL of a 0.9 % sodium saline solution on the basis of endoscopic and clinical parameters in children with chronic adenoiditis associated with recurrent acute otitis media and otitis media with effusion; age- and gender-matched children receiving normal 0.9 % sodium chloride saline solution were used as controls. Analysis was based on 103 (mean age 63.3 ± 18.2 months; 52 males, 50.5 %) children: 54 in the study group and 49 in the control group. A statistically significant reduction in the mean number of all acute otitis media episodes (AOME) (mean reduction 0.8 ± 0.4 per month; p value 0.05) and AOME without tympanic membrane perforation (mean reduction 0.6 ± 0.3 per month; p value 0.04) after recruitment was documented only in the study group. HA significantly improved all the endoscopic outcomes (p values ranging between 0.05 and

Some considerations will be expressed in consideration of the commentary previously published. In particular, we underline that no other medications were administered to the patients during the study period and any clinical evaluation was postponed in case of acute upper respiratory tract infection in the previous 14 days. We strongly advocate antibiotic treatment during any acute otitis media episode, and we agree that topically administered hyaluronic acid should be considered as a supporting treatment, “complementary to traditional therapies” in children with recurrent disease.

Sir, Although stapes surgery currently represents one of the most common surgical procedures in ENT practice, there is still an unsolved debate about the necessity of packing the external auditory canal (EAC) after surgery [1[e1]]. Some of the questions are: packing the EAC or not? In case of packing, what kind of packing is most convenient? Reabsorbable material or removable tampon? What about Wxing the tympanomeatal Xap with Fibrin Glue “Tissucol”? The Wrst author has performed more than 300 stapedotomies in the last 15 years, using mostly ear packing at the end of the surgical procedure, while the last author has operated more than 3,000 stapedotomies in the last 30 years, using mostly Wbrin glue in the last 10 years. The comparison of our diVerent experiences, together with those of the other authors who have assisted the two surgeons, leads to the following common considerations. Ear packing performed with reabsorbable tampon, like absorbable gelatin sponge (Gelfoam), assures an excellent hemostatic eVect and allows repositioned tympanomeatal Xap to heal in the correct position [2]. The following inconveniences have been observed: the mechanical interposition of gelatin between the skin edges may interfere with healing (http[K2]://www.pWzer.com/pWzer/main.jsp); gelatin may represent a nest for infection and has been reported to potentiate bacterial growth (http[K3]:// www.pWzer.com/pWzer/main.jsp); toxic shock syndrome has been reported in association with the use of Gelfoam in nasal surgery [3]; fever, failure of absorption, and hearing loss have been reported in association with the use of Gelfoam during tympanoplasty (http[K4]://www.pWzer. com/pWzer/main.jsp). However, it is not recommended that gelatine sponge is saturated with an antibiotic solution or dusted with antibiotic powder (http[K5]://www.pWzer.com/ pWzer/main.jsp). Ear packing with removable tampon, like non-absorbable sponge (Merocel tampon), assures an excellent absorption of post-operative excess Xuids and provides the expansion of the canal with an anatomically correct healing of tissues. It can also help to keep antibiotics in contact with the surgical site and its removal (3–7 days after surgery) is atraumatic. Conversely, like reabsorbable tampon, non-absorbable sponge tampon can give rise to local infection or formation of granulation tissue. Moreover, both packing strategies cause aural fullness, described by the patient as uncomfortable [1, 4]. Not packing does not allow a control of post-operative hemostasis and of tissue healing as precise as in the case of packing, especially in the stapes procedures without ear drilling canal and performing endoaural approach advocated by Fisch. In the case of signiWcant post-operative drainage, the tympanomeatal Xap can be displaced from its correct position and middle ear infection with sensorineural hearing loss can result [1]. Fibrin glue (Tissucol) used to Wx the repositioned tympanomeatal Xap encourages healing in its correct anatomical position. Moreover, since no packing is performed, the patient’s postoperative comfort is greatly enhanced and hearing improves directly after surgery [1]. The risk of infection is theoretically reduced by the absence of post-operative stagnation of Xuids. Without F. Salvinelli · M. Casale (&) · V. Rinaldi Department of Otolaryngology, Interdisciplinary Center for Biomedical Research (CIR), University “Campus Bio-Medico” School of Medicine, Via Longoni, 69/83, 00155 Rome, Italy e-mail: m.casale@unicampus.it